title: Coexistence of Graves' disease, papillary thyroid carcinoma and unilateral benign struma ovarii: case report and review of the literature.
abstract: BACKGROUND
  Struma ovarii is a rare cause of hyperthyroidism, while coexistence with Graves' disease has been scarcely reported.
  
  
  METHODS
  We report a patient with Graves' disease and unilateral benign functioning struma ovarii, accompanied by ascites, pleural effusion and elevated cancer antigen-125 (CA-125) levels. In subsequent thyroidectomy, incidental papillary thyroid carcinoma was also identified. The functionality of struma ovarii tissue in our patient was supported by the immunohistochemical identification of TSH receptors (TSHR), which may stimulate growth and thyroid hormone production in the presence of circulating TSHR stimulating antibodies (TSHR-Ab).
  
  
  METHODS
  A systematic review of reported cases of coexistent Graves' disease and struma ovarii was performed.
  
  
  CONCLUSIONS
  The diagnosis of struma ovarii may be masked by Graves' disease and, therefore, be delayed for several years. Furthermore, ascites, pleural effusion and increased CA-125 may result from a benign struma ovarii. The presence of TSHR in the struma ovarii tissue along with their absence in the surrounding ovarian tissue indirectly suggests that struma ovarii is functional. It is unclear whether TSHR-Ab play a role in the development of thyroid carcinomas in such patients.
authors.affiliation: Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece. Electronic address: anastath@endo.gr.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Anastasilakis
authors.forename: Rosaria-Maddalena
authors.initials: RM
authors.lastname: Ruggeri
authors.forename: Stergios A
authors.initials: SA
authors.lastname: Polyzos
authors.forename: Polyzois
authors.initials: P
authors.lastname: Makras
authors.forename: Dimitra
authors.initials: D
authors.lastname: Molyva
authors.forename: Alfredo
authors.initials: A
authors.lastname: Campennì
authors.forename: Athina
authors.initials: A
authors.lastname: Gkiomisi
authors.forename: Christos
authors.initials: C
authors.lastname: Balaris
authors.forename: Panagiotis P
authors.initials: PP
authors.lastname: Fotiadis
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tuccari
authors.forename: Stergios
authors.initials: S
authors.lastname: Papachatzopoulos
mesh_terms: D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D002291:Carcinoma, Papillary; D005260:Female; D006111:Graves Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013330:Struma Ovarii / Q000175:diagnosis* / Q000473:pathology; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology
keywords: CA-125; CT; Hyperthyroidism; Meigs syndrome; Pleural effusion; TFTs; TG-Ab; TPO-Ab; TSH; TSH receptor; TSHR; TSHR-Ab; Thyroid cancer; US; cancer antigen-125; computed tomography; thyroglobulin autoantibodies; thyroid function tests; thyroid peroxidase autoantibodies; thyrotropin; thyrotropin receptors; thyrotropin receptors autoantibodies; ultrasound